Dilemmas in Military Medical Ethics: A Call for Conceptual Clarity

Abstract

Despite the increase in and evolving nature of armed conflicts, the ethical issues faced by military physicians working in such contexts are still rarely examined in the bioethics literature. Military physicians are members of the military, even if they are non-combatants; and their role is one of healer but also sometimes humanitarian. Some scholars wonder about the moral compatibility of being both a physician and soldier. The ethical conflicts raised in the literature regarding military physicians can be organized into three main perspectives: 1) moral problems in military medicine are particular because of the difficulty of meeting the requirements of traditional bioethical principles; 2) medical codes of ethics and international laws are not well adapted to or are too restrictive for a military context; and 3) physicians are social actors who should either be pacifists, defenders of human rights, politically neutral or promoters of peace. A review of the diverse dilemmas faced by military physicians shows that these differ substantially by level (micro, meso, macro), context and the actors involved, and that they go beyond issues of patient interests. Like medicine in general, military medicine is complex and touches on potentially contested views of the roles and obligations of the physician. Greater conceptual clarity is thus needed in discussions about military medical ethics.Malgré l’augmentation des conflits armés et des changements qui les caractérisent, les enjeux éthiques auxquels font face les médecins militaires sont très peu traités dans la littérature en bioéthique. Les médecins militaires sont des membres du corps militaire, même s’ils sont non combattants, et ils jouent un rôle de soignant tout en pouvant être appelés à agir comme aide humanitaire. Certains auteurs se sont même interrogés sur la compatibilité morale d’être à la fois médecin et soldat. Les conflits éthiques soulevés dans la littérature sur les médecins militaires peuvent être organisés autour de trois perspectives : 1) les problèmes moraux en médecine militaire seraient particuliers compte tenu des difficultés à respecter les principes bioéthiques traditionnels; 2) les codes d’éthique médicaux et les lois internationales seraient trop restrictifs ou inadéquats pour le contexte militaire; et 3) les médecins sont des acteurs sociaux qui devraient être pacifistes, défenseurs des droits de la personne, politiquement neutres ou promoteurs de la paix. Une revue des divers dilemmes rencontrés par les médecins militaires identifiés dans la littérature nous montre que ces perspectives se situent à des niveaux d’analyse différents (micro, méso, macro), que les contextes et les acteurs impliqués sont souvent différents et que les dilemmes vont bien au-delà des enjeux liés strictement à l’intérêt du patient. Tout comme la profe...

The Meanings Soldiers Attach to Health and Their Impacts on Primary Health-Care Utilization and Avoidance in an Australian High-Risk Combat Unit

“…Unlike civilian health professionals, who are guided by bioethical principals which afford primacy to the individual, military clinicians must sometimes forego individual primacy and act in favor of the organization (Dobmeyer, 2013; Johnson, 2008; Johnson, Grasso, & Maslowski, 2010; Rochon, 2015). Within academic literature, this duality of interests (i.e., the individual soldier vs. the organization) has been explored conceptually (Gross, 2013; London, Rubenstein, Baldwin-Ragaven, & Van Es, 2006; Rochon, 2015), interpreted through clinical scenarios and case studies (Dobmeyer, 2013; Johnson et al, 2010), and empirically researched (Gordon, 2014). In these studies, duality is discussed as problematic for clinicians, contributing to a felt tension as they balance individual needs with the needs of the organization; however, any potential impact on the health and health behaviors of military personnel has been relatively unexplored.…”

Whose side are you on? Complexities arising from the non-combatant status of military medical personnel

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“…Countless doctors during the World Wars thought the answer was "yes", although they reported moral conflict in doing so (Jones 2008) as have military doctors (reportedly against their own medical judgement) in contemporary conflict. (Rochon 2015) Should a doctor prescribe medications with the intention of enhancing the combat ability of the fighting force, even in the knowledge that such medications (such as stimulants, (Eliyahu et al 2007), anabolic steroids, unproven vaccines [e.g. anthrax during the first Gulf War], and experimental nerve protectant agents [e.g.…”

Thematic Analysis of Military Medical Ethics Publications From 2000 to 2020—A Bibliometric Approach

“…The past two decades of conflict, especially in Iraq and Afghanistan, have led to public debate about the ethical professional practice by members of military health services. 1 , 2 Appropriately, both Gross 3 and Rochon 4 have called for clarity from practitioners and scholars on the principles and topics within the domain of military medical ethics (MME) in 2013 and 2015, respectively. Later in 2015, the International Committee of the Red Cross published a consensus document in concert with the World Medical Association, the International Committee of Military Medicine, the International Council of Nurses, and the International Pharmaceutical Federation entitled “Ethical Principles of Health Care in times of Armed Conflict and other Emergencies”.…”